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Infant Male Circumcision: A Medical Perspective
Infant Male Circumcision: A Medical Perspective
https://ift.tt/2rEFIDM December 01, 2019 at 09:20AM https://ift.tt/1R552o9
Seizing the Opportunity in America’s Opioid Crisis
“Perhaps everything that is terrible is, in the deepest sense, something that wants our love.” – Rilke
The overdose epidemic in the U.S. has been called “the greatest public health crisis of our time.” It’s also our greatest opportunity.
The opioid crisis is an identity crisis: it’s a challenge to how we see ourselves. Do we truly believe that we are all in this together? One answer leads us deeper into despair. The other, into a hopeful future.
It’s been said that “doing more things faster is no substitute for doing the right things.” What are the “right things,” the measures that can resolve the crisis, not just postpone it? The right actions come from the right thoughts. Those thoughts come from feelings, and feelings are never right or wrong. But there are some feelings we are born with. They are our birthright. And one of them is love.
The Kindness of Strangers
“Hatred never ceases by hatred, but by love alone is healed.” — The Buddha
Behind the opioid epidemic is a prevailing lack of compassion, of caring about everyone equally. At the heart (or lack of it) of this societal disease is rampant inequality. The social determinants of health: stress, unemployment, lack of support, poor health care, etc. are major drivers of addiction. Many authors promote this view, including Gabor Mate, Bruce Alexander, Sam Quinones, Robert Putnam, and Harry Nelson.
Our increasing fragmentation affects everyone, poor or rich.
“Drug overdose is the leading cause of death for Americans under the age of fifty…Our material lives may be outwardly prosperous, but our psychological and spiritual lives are in freefall. What is driving us to self-destruction? There are many factors, all with one unifying theme: we are no longer living in community with one another and, consequently, we are lonely.” — Francie Hart Broghammer
We all hunger for the same thing. The question is this: do we love our neighbor as ourselves? That’s not just a commandment; it’s a requirement. How do we rebuild community? First, by taking full responsibility for the fallout of not being one.
For Whom the Boom Tolls
“Compassion is not a relationship between the healer and the wounded. It’s a relationship between equals. Compassion becomes real when we recognize our shared humanity.” — Pema Chodron
I live in Asheville, a city that has recently, like the opioid crisis, exploded. Tourism is at an all-time high, and Asheville has appeared in dozens of destination top ten lists. It has also been ranked second in the country in gentrification.
Asheville sits in the heart of Appalachia, where the opioid crisis is at its worst. In 2017, North Carolina had the second highest increase in opioid deaths in the country. The Blue Ridge Parkway runs through town and I spend a lot of time there, mostly foraging. That’s where last summer, for the first time, I found not mushrooms, but needles.
Despite the crisis, the city just spent six months trying to shut down the local syringe exchange. The same thing is happening in other cities. In Asheville, the exchange had been operating without incident for over two years — until the houseless (a.k.a., homeless) in adjacent areas were kicked out to make way for new development.
Addiction depends on denial. What if development is the real addiction? Will we face up to the dark side of gentrification or just try to make it “go away?”
If a canary dies in a coal mine, you don’t blame the canary. Yet blaming the victim is exactly what we’ve been doing.
License to Ill
“A man came to the Rabbi and said, ‘Rebbe, my son has turned against me. What should I do?’ The rabbi said, ‘love him even more.'” — Hasidic story
Most people by now have heard that naloxone (Narcan) can prevent a deadly overdose. So many Americans are dying — often from a mix of drugs, but mainly due to opioids — that naloxone should be as ubiquitous as aspirin. Everyone using a drug that may contain opioids should carry it like an EPI pen. And with the increasing prevalence of fentanyl, a single dose may not be enough. Everyone should know how to tell how much naloxone to give someone in the midst of an overdose. This should be basic, universal knowledge.
But keeping someone alive is just the beginning. In fact, while naloxone may be physically safe, it does have one significant side effect: precipitated withdrawal. And not helping someone through it is like catching them from falling only to drop them from higher up.
A Devil’s Bargain
“Be kind, for everyone you meet is fighting a hard battle.” — Ian Maclaren
As one response coordinator describes it, precipitated withdrawal is like “the worst flu you’ve had… times 100.” For some, the feeling is so bad that they find themselves dying, so to speak, to use again.
“To the uninformed, it is inconceivable that someone who nearly died from a drug would run out that very same day and buy more of it. Narcan works by binding to opioid receptors, blocking the effect of narcotics like heroin. In drug users with a physical dependency, it also has the effect of causing severe withdrawal symptoms. This all but guarantees that the first thing a user will think of after their overdose is reversed is getting another fix…” — Christopher Moraff
Naloxone is not just a “bandaid on a bullet hole.” It can feel like ripping open a wound. For “withdrawal is the very situation that [users] are seeking to avoid in the first place.”
“A dose of naloxone,” according to the Chief Medical Officer for a Connecticut health agency, “is a chance. But if it’s not coupled with immediate offers of treatment, it may be a slim chance that leaves the revived individual running back to the same dealer who sold them their last lethal dose.”
Overdose survivors need more than a second (or third) chance: they need a parachute.
When you’re in free fall, a little more time isn’t much help…
Find out why Alan feels we should take responsibility for the opioid crisis — and why this crisis is an opportunity and a “wake-up call” — in the original article The Opioid Crisis Is Our Greatest Opportunity at The Fix.
When Every ADHD-Friendly Organizing Tool and Trick You’ve Tried Hasn’t Worked
You feel like you’ve tried every technique, tool, and trick to get organized. But nothing seems to work. Tasks still go unfinished, and you still find yourself frustrated and stressed out.
The problem?
Maybe your systems have simply lost their spark. “The ADHD brain likes novelty,” according to Barb Hubbard, M. Ed, AAC, an ADHD specialist and life strategies coach. “So, when you find a system that works, expect the newness to wear off after a while. Know that it’s OK to change systems often or make small changes that allow you to feel like it’s new again.”
Maybe you’re fixated on perfection. “When you set yourself up to do something ‘perfectly,’ it’s not going to work and perfection is a big barrier to the outcome of your success,” said Annie Varvaryan, PsyD., a clinical psychologist working with adolescents, adults, and couples in private practice in San Jose, Calif. Instead, realize that “some of it will work and other parts will pan out differently than expected,” she said.
Maybe you’re skimping on self-care and other focus-bolstering habits. Gayle M. Gruenberg, a coach and professional organizer in chronic disorganization who specializes in working with clients with ADHD and other brain-based challenges, noted that these habits include: getting good sleep; exercising; eating nutrient-rich foods; going outside; and working in an optimal environment for you (which might mean quiet and calm or lots of commotion).
Maybe some strategies haven’t worked because you need a pharmacological solution. Or maybe you need to switch medication or increase your dose. This is when it’s important to see a psychiatrist who specializes in treating ADHD (if possible).
Whether you’re taking medication or not, there are plenty of other strategies that can help—like the ones below.
Have ongoing support. Gruenberg has found that this is the most effective technique for people with ADHD. “Whether it’s a family member, friend, or a professional—organizer, coach, therapist—having someone to be accountable to is very helpful.”
She noted that having an external support system can assist with everything from helping you find strategies that work to validating your challenges and surrounding emotions.
Find out what else is going on. Often individuals with ADHD have other conditions that can affect how they learn and process information, and thereby the tools that will be effective. This might be anything from a learning disability to a mood disorder. This is why it’s important to get a comprehensive professional evaluation.
Meditate. Today, meditation is a common recommendation for everything. But it can absolutely help to sharpen your focus. For instance, studies show a link between regular meditation and thickening of the prefrontal cortex, home of executive function skills, such as attention, organization, planning, decision making, judgment, and self-regulation, noted Marilyn Abrahamson, a speech-language pathologist and Amen Clinics certified brain health coach.
“People with ADD commonly have behavior changes that are associated with these areas of the brain, which is why meditation is so effective in this population.”
For Abrahamson, who also has ADHD, meditation has been tremendously helpful. She suggested starting with a guided meditation, such as an app (like Calm or Headspace) or a free video on YouTube. The great thing is that there’s a wide array of options, she said—from a single minute to an entire hour, from men’s voices to women’s voices, from soft music to babbling brook sounds.
“I find that what works best for me today is different from what I chose from yesterday’s meditation. The most important thing is that you take the time to do it each day.”
Create rewards. If you’re motivated by them, rewards can inspire you to get things done. Varvaryan noted that “a reward could be something that the person wants to do or build toward doing.” An example, she said, is “If I complete my tasks every week for four weeks, I can buy the concert tickets I want.”
Delegate effectively. Gruenberg’s mantra is: “Do what you do best and delegate the rest.” What are your strengths? What feels easy for you? What feels excruciating? Can you assign the task to someone else? Maybe you can hire out. Maybe a colleague is better suited for that part, while you can focus on a different area of the project.
Always write it down. Abrahamson uses Google calendar to set reminders. She also uses Siri and the iPhone note-taking app to capture thoughts and ideas that pop up, even in the middle of the night. “Just noting it somewhere gives me the confidence that the information is ‘safe’ and I can go back to sleep without worrying that I’ll forget it.” Phones are a great way to record reminders, because, let’s be honest, they’re constantly with us.
Set a timer. Timers create a sense of urgency for all sorts of tasks, and they help you get started. (Often getting started is the hard part!) For example, Hubbard suggested setting a timer for 10 minutes every day to clear your desk. You also might set a timer for tedious tasks (which can’t be delegated).
Create routines. Routines can help you accomplish the tasks that really require effort, because routines allow you to move through everyday activities without much brain power, said Hubbard. For example, she said, you might create this bedtime routine: Turn off all screens by 9 p.m., journal about what went well, meditate for a few minutes, set out clothes for the next day, brush your teeth, take your medication, and settle into bed with a book.
To create routines, Hubbard suggested these tips:
- Always follow the same steps in the same order.
- Identify three things that are vital to you, and create your routine around them. You can add additional steps later.
- Create a visual reminder of your new routine. For example, you might write your list on a post-it note and put it on your bathroom mirror.
- Pair activities that are already routine (e.g., brushing your teeth) with new activities (e.g., taking medication).
- Keep your routines no longer than 15 or 20 minutes. “You want to create a routine that will lead to success and build on it from there.”
Have a minimalist mindset. Instead of adding one more thing, work on subtracting. According to Derek Mihalcin, Ph.D, a psychologist and board-certified behavior analyst, you might: turn off TV during family dinners; keep your phone on silent during meetings; and focus on three tasks (rather than starting your day with a running list of everything). He also stressed the importance of single-tasking. Then if you complete those three tasks, move on to the next three.
When trying a strategy, try not to get discouraged. Think of yourself as a scientist or an explorer. You’re simply experimenting to see what works and what doesn’t. Everything is invaluable information that helps you adjust, pivot, and change course. So, if a strategy doesn’t work, reflect on the reasons why—and then try something else that might be a better fit.
Google attempts to protect users from sketchy stem cell clinics - Google's new policy banning stem cell ads started at the end of October.
Google attempts to protect users from sketchy stem cell clinics - Google's new policy banning stem cell ads started at the end of October.
https://ift.tt/2L8XRjY December 01, 2019 at 02:07AM https://ift.tt/1R552o9
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China to use drug bulk-buy program to close price gap
China to use drug bulk-buy program to close price gap
Reuters: Health
China will use its national drug bulk-buy scheme to lower the price of drugs currently sold at higher prices compared with other markets, it said in an official statement.
Reuters: Health
China will use its national drug bulk-buy scheme to lower the price of drugs currently sold at higher prices compared with other markets, it said in an official statement.
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